ER NAVIGATOR

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ER NAVIGATOR

• Community Outreach for Personal Empowerment

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ER Navigator Pilot Program

• Purpose to connect self pay patients who are
  accessing the ER for primary care, with a
  community provider that they will then continue
  to access and value as their medical home

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Process

• Navigators are trained as Certified Community
  Health workers
• The program works collaboratively with Harris
  County Hospital District/Gateway to Cares
  Navigator Program
• ER staff and navigator communicate jointly to
  patients regarding the benefits to be derived in
  obtaining timely, continuity community care
• Navigator makes referral and continues to
  follow-up with patients by phone until one of the
  following occurs
• Patients are happy with the referral and
  understand the continued use
• Patients ask not to be contacted
• Patients are unreachable (after 3 follow-up
  attempts)

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Effective communication from Physicians and
nurses is essential to the process

• Do you have a medical home a doctor or clinic
  where you get routine care and can call for any
  reason?
• If yes, reinforce need to use that source (tie
  that reinforcement to their clinical condition)
• If no, you know it is really important for your
  health that you get routine care. Not only will
  that physician deal with your ________ that
  brought you here today, but conditions like blood
  pressure, blood sugar or cholesterol that can
  really impact your health will be dealt with as
  well. Im going to connect you to our Navigator
  who will help you find a medical home that is
  affordable. I really want you to make an
  appointment and start getting routine care.
• Personalize it. I dont want to see you in here
  with a stroke because you didnt get that blood
  pressure controlled.

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Activity to Date

• Navigator began 1/2/2008
• Hours are 1130-800, M-F
• 384 unduplicated patients counseled
• 1097 contacts2.9 per patient (follow up contacts
  made by phone on weekends)
• Primary referrals
• Echos, Christus, IBN SINA, Neighborhood Health
  Center, Hope Community Health Center

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Challenges

• Consistency of ER referrals
• Placement of Navigator within the ER (more
  effective to have the program associated with the
  clinical process versus the financial process)
• Difficulty reaching patients for desired
  follow-up

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Next Steps

• Outcome process
• A random sample of people will be contacted 6
  months following service and asked the following
  to determine program effectiveness
• What is the health home for yourself?
• What is the health home for other family members?
  
• How many times have you visited the ER since you
  received Navigation Services?
• With adequate outcomes, additional navigators
  will be strategically added within Memorial
  Hermann emergency rooms

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The connections..

• 1/2/08 Mr. Salinas came to the SW/ER for
  seizure. Navigator referred him to Christus
  Clinic and to ECHOS (for Gold Card).
• 1/24/08 Navigator called Patient for
  follow-up on referrals given. Patients wife
  reported that they had been to ECHOS and were
  helped greatly. She stated that going to ECHOS
  was like a big door that had been opened for
  them.
• Wife stated that Patient was able to be seen at
  Martin Luther King Health Center and Patient will
  be treated there.
• 3/11/08 Navigator called Patient for
  follow-up on healths status. Patients wife
  stated that Patient is being treated at MLK and
  has an appointment to go to Ben Taub for an MRI.
  Patients wife stated that he is doing great, but
  the MRI is to make sure that nothing else is
  wrong.
• Patients wife is very pleased to have been to
  ECHOS. They helped them with a temporary Gold
  Card and soon they will apply for a Gold Card
  that will be good for a year. Through ECHOS they
  also got an appointment to go to the University
  of Texas-Vision Branch. She said that she is
  going to become a volunteer at ECHOS.
  

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The connections..

• 2/29/08 Ms. Butler came to the SW/ER with
  abdominal pain.
• Patient referred to IBN SINA Clinic and to ECHOS
  (for gold card).
• 3/10/08 Navigator called Patient for
  follow-up on referrals given. Patient stated
  that she was pregnant and would be receiving
  Medicaid benefits and would see a Medicaid
  doctor. Navigator closed the cased since
  Patient had a plan.
• 3/13/08 Navigator received a call from the
  Patient. She stated she needed a referral to go
  to a doctor in the interim of waiting for
  Medicaid. Navigator referred her to HOPE
  Community Health Center.
• 3/24/08 Navigator called Patient for
  follow-up on referral. She had been to the HOPE
  Clinic. She also now has Medicaid. The Patient
  stated that she would keep the HOPE Clinic
  reference for future needs.